Dietary advice for people with diabetes   (July 5, 2008)

Everyone involved in the management of people with diabetes would probably agree with the ADA's Position Statement that "Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention... MNT is also an integral component of diabetes self-management education (or training)."

Accordingly, I was quite surprised at the results of a recent poll, where I had asked readers at my DiabetesMonitor.com website to answer the question, "Have you reviewed your meal plan with a dietitian?" Almost half of the respondents who had diabetes indicated that they have not done so, although a few hinted that they would be doing so.

This raises the obvious question: Where are these folks getting their advice about diabetes meal planning? I have a few suspicions, and not many of them are pretty.

The first and best assumption might be that the review was with a trained CDE, such as a diabetes nurse educator, who would have approximately the same knowledge as a dietitian about meal planning. Actually, anyone with the CDE credential, whether dietitian, nurse, physician, pharmacist, or other healthcare specialist, has to pass a comprehensive exam that includes a large component of dietary information, and another large component on teaching skills.

The second would be from a physician, and if that's where the dietary review occurred, I'm very uncomfortable. Not many physicians are trained in diabetes meal planning, few have an interest in teaching, and fewer still have the time. Sadly, I can recall hearing of physicians tearing off a preprinted meal plan from a pack of 50, and advising the patient to "go eat this." Maybe eating the paper itself would have provided some fiber, but the information on these tear-offs is obviously not individualized and notoriously inadequate.

And the third? Learning from friends or family, or discussion groups on the Internet. But misinformation abounds with nonprofessional advice, such as the common admonition  that "people with diabetes can't eat [fill in the blank]". Even well-meaning advice wouldn't necessarily capture other health issues that should be incorporated into a meal plan, such as caloric, lipids, sodium, or other restrictions that might be appropriate.

And what I suspect is mostly likely? No education whatsoever on what to eat. Why might this be? Well, for one thing, teaching diabetes meal planning is difficult to do, and ideally should be reinforced with multiple sessions. Another: reimbursement for teaching meal planning is sometimes difficult to obtain. Then there's the issue of who's doing the cooking: if it's not the patient, then reaching out to the cook is critical. And people's resistance to change is especially true for changing long-held habits such as food preferences.

So, I'll ask you the same question as I asked in the poll: "Have you reviewed your meal plan with a dietitian?" If you haven't done so at all, or if it's been a number of years, it might be a good idea to do so.